Research: “Religiosity” and Depression

Harold Koening, Linda George and Bercedis Peterson’s article “Religiosity and Remission of Depression in Medically Ill older patients” published in the American Journal of Psychiatry (155.4, 1998) was one of the first studies that used religiosity to predict outcome in depressive illness. Their abstract follows:

Objective: The effects of religious belief and activity on remission of depression were examined in medically ill hospitalized older patients. Method: Consecutive patients aged 60 years or over who had been admitted to medical inpatient services at a university medical center were screened for depressive symptoms. Of 111 patients scoring 16 or higher on the Center for Epidemiologic Studies Depression Scale, 94 were diagnosed with depressive disorder (DSM-III major depression or subsyndromal depression) by a psychiatrist using a structured psychiatric interview. After hospital discharge, depressed patients were followed up by telephone at 12-week intervals four times. At each follow-up contact, criterion symptoms were reassessed, and changes in each symptom over the interval since last contact were determined. The median follow-up time for 87 depressed patients was 47 weeks. Religious variables were examined as predictors of time to remission by means of a multivariate Cox model, with controls for demographic, physical health, psychosocial, and treatment factors. Results: During the follow-up period, 47 patients (54.0%) had remissions; the median time to remission was 30 weeks. Intrinsic religiosity was significantly and independently related to time to remission, but church attendance and private religious activities were not. Depressed patients with higher intrinsic religiosity scores had more rapid remissions than patients with lower scores. Conclusions: In this study, greater intrinsic religiosity independently predicted shorter time to remission. To the authors’ knowledge, this is the first report in which religiosity has been examined as a predictor of outcome of depressive disorder.

The problem here is the exact definition of “Religiosity”. The mechanism they use meets statistical testing,  but “intrinsic religiosity” is measured using 10-question proforma about religious beliefs, activities and experiences. Christian and Jewish minister were asked to select what responses they thought an intrinsically religious person would hold. I’m not entirely comfortable with this means of assessing religiosity/spirituality, nor am I comfortable with subjecting religious belief to quantiative analysis, although I can see it’s necessary.

However, unsurprisingly, Intrinsic religiosity (i.e. some spiritual life, belief and activities) was linked to good outcomes for depressive illness. Perhaps more surprisingly, Church attendance wasn’t.

Historic Article: St Paul on Depression

Back in 1967 Mark Altschule reflected in the British Journal of Psychiatry on St Paul’s word in 2 Corinthians 7:10 in relation to the classification of depression.

His article is available online here, part of it for free.

Interesting Forthcoming Research: Psalms and Death and Dying

Dr Daniel R Driver, sometime postgraduate student of St Mary’s College St Andrews and currently Assistant Professor of Religion Studies at Tyndale University College, has some interesting research planned:

Biblical scholars have long noted the disconnect between the finality of death in the Hebrew Bible and traditional Jewish and Christian doctrines of an afterlife. Developmental explanations have won broad support. A neglected aspect of the problem, however, is the way in which the Hebrew Scriptures themselves supported later belief in life’s triumph over death. By tracing the reception history (Wirkungsgeschichte) of a series of key psalms—for the Psalter is where we find the most extreme statements of death’s overwhelming power (e.g., Psalms 6, 18, 22, 30, 88, 116)—this monograph-length study will contribute to an understanding of how a late biblical idea was retrospectively transferred to, or read from, older language. 

Aside from being extremely interesting of itself, I am convinced Dr Drivers’ research will be useful to ministers engaged in care of the dying and the bereaved who seek to employ the Psalter, and for the pastoral care of nurses and other healthcare professionals, who are confronted with the reality of death and dying in their daily work.

Article: “Towards a rhetoric of spirituality in mental health care”

Back in 1996, Peter Nolan and Paul Crawford of the University of Birmingham (UK) issued an interesting article in the Journal of Advanced Nursing entitled: “Towards a rhetoric of spirituality in mental health care“.

Abstract (emphases mine):

The spiritual dimension of care is frequently alluded to in the nursing literature, but rarely examined in terms of what it means in practice or how it might be taught to students entering the profession. Some of those most in need of spiritual care are people suffering from mental illness or psychological distress. The aim of this paper is to explore the different meanings of spirituality and to suggest ways in which the spiritual care of clients can be implemented. It further recommends which aspects of spirituality could usefully be included in nursing curricula. The paper concludes by alerting nurses to the causes and manifestations of spiritual apathy in contemporary health care and calls for a rhetoric that will counter the jargon of cost analysis which currently prevails in the health services.

Obviously, this was written more the 10-years ago, but it remains very relevant. My own perspective is that whilst spirituality now features on the curriculum of many nursing programmes, little is done to help bridge the theory-practice gap in this area. Increasingly, “spirituality” and “religion” are equated, and – alarmingly – associated with post-mortem care planning (arranging for appropriate rituals to be observed, etc). Spirituality has become associated with ritual and is regarded as the domain of the chaplaincy department – who are regarded as professional spiritual carers.

Spiritual care has been compartmentalised in the same way that surgical intervention has. Nursing care plans often fail to realise that nurses cannot avoid implementing “spiritual care” – the interaction of two individuals is one rooted in a common, spiritual, experience of personhood. Student nurses, who endeavour to become skilled in caring for the human spirit, must learn a “way of being” with patients – an approach to spending time with, valuing and dignifying the human persons that are commended to their care. Christian theology contributes to this by understanding humanity in the Imago Dei, and by acknowleding a relational ontological approach to ethics.

As this article emphasises, therefore, spirituality is the necessary and universal responsibility of all healthcare practitioners. The responsibility for spiritual education of nurses falls both in the theoretical confines of the university and in the practical setting of the ward. Nursing theology and spirituality is cut at the coal-face of the nurse-client relationship. Nursing theology provides not a cognitive-proposition focussed set of data, but a grammatical framework which serves to regulate and add meaning to our common experience of humanity. Nurses are therefore tasked to become experts in human spirituality, even if their primary duty is not that of the pastor – to facilitate the encounter between man and God.

Article: Mental Health Chaplaincy

Lorna Rattray offers a profound reflection on 6-years work as a Mental Health Chaplain. Full text article available free, in PDF format.

Abstract:

This article reflects briefly on 6 years of mental health chaplaincy work. It stresses the common humanity, with its needs and vulnerabilities, of chaplain and patients, and the need for openness in relationships. Worship in the hospital, and its relationship with the realities of life is considered. The article ends with a reminder of the dependence of us all on the incarnate God.

My highlight:

God does not stand off from us, as the ‘expert in human life’ who hands out ‘his’ wisdom and guidance to us when we come to ‘him’ pleading for help.

Rather, God comes to us in the incarnate Jesus, who identifies with us in our human predicament, and teaches us, out of his own experience, both how to discover and develop our full humanity, and the truth that, however desperate we may feel – ‘my God, my God, why have you forsaken me?’ (Psalm 22.1; Matthew 27.46; Mark 15.34) – our God is with us, and we can depend on him.

Coming Soon (June 2009)!

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